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Aspirin — good or bad?

Doctors say benefits and risks of aspirin depend on individual health

By Joyce Davis

For the Reporter-Herald

Posted:
03/23/2014 08:27:01 PM MDT

Medical professionals say aspirin has many benefits, but because it also may be harmful in some cases, people should use it for preventive purposes only under a physician's direction. (Jackie Hutchins / Loveland Reporter-Herald)

What is aspirin?

Aspirin, or acetylsalicylic acid (ASA), is a salicylate drug, generally used as an analgesic (pain relief without anesthesia or loss of consciousness) for minor aches and pains, to reduce fever or as an anti-inflammatory drug. Aspirin is the first discovered non-steroidal anti-inflammatory drug (NSAID).

Aspirin also is used as an anti-platelet to prevent blood clot formation, usually in long-term low doses to prevent heart attacks and strokes in high-risk patients. It is also often given to patients immediately after a heart attack to prevent recurrence or cardiac tissue death.

Salicylate is found in such plants as willow trees and myrtle.

The word aspirin is a trademark owned by Bayer, a German pharmaceutical company, and in its present form has been around for more than 100 years.

One of the world's most widely used medications, it's estimated that approximately 40,000 metric tons of it is consumed annually.

History of aspirin

Mention of aspirin, as a willow tree-based remedy, goes back to 3000 B.C. Mesopotamia, and also as a pain and fever treatment in 14th-century Egypt. From ancient Greece to Rome and in some Arab countries, willow bark, willow leaves and myrtle were known to have healing properties.

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Aztec and Mayan folklore mentioned the use of the willow-based remedy, while traditions among the Huron, Cree, Mohawk and Chippewa prior to European arrival in America spoke of the use of white willow bark and twigs as the basis for teas to ease pain. By the 1800s, European scientists attempted to isolate and purify salicylic acid as discovered in 1763 by Edward Stone, of England. Later, German, French, Swiss and Italian chemists formulated salicylate medicines widely used between 1840 and 1894.

During this same time, German chemists working for the Bayer pharmaceutical group developed acetylsalicylic acid under the brand name Aspirin. By 1915, aspirin in tablet form was available over the counter.

In 1948 physicians reported lower rates of heart attack in patients who regularly took aspirin. Chewable aspirin became available in 1952 and the drug went to the moon in 1969, included in medication kits for the Apollo astronauts.

Between 1988 and 1998, the Food and Drug Administration approved of the use of aspirin in reducing the risk of recurrent myocardial infarction, heart attack and patients with unstable angina, also as a preventative medication for mini-strokes and as a low-dose addition to hypertension medication.

Cautions for aspirin use

Experts recommend that you talk to your doctor before taking aspirin if you:

Are pregnant, trying to conceive or are breast-feeding.

Regularly consume alcohol (the Mayo Clinic suggests if you are on daily aspirin, you should limit your alcohol consumption to one drink or less per day if you are a woman, or two drink or less if you are a man).

Have a blood disorder, stomach ulcer, asthma, high blood pressure, kidney or liver problems, or allergies to any drugs.

Are taking vitamin supplements or ibuprofen, which reduces the benefits of the aspirin.

Are taking warfarin or other anti-clotting agents — all of which increase the risk of bleeding.

For more than a century, aspirin has been the go-to drug for the relief of pain and inflammation and, later, as a preventative for heart disease. Now, recent studies seem to indicate aspirin offers protection from melanoma and other cancers. But many experts remain cautious and urge people to refrain from popping an aspirin on their own to thwart possible disease.

A study published in the Feb. 6 edition of the Journal of the National Cancer Institute found that women who take aspirin daily may reduce their risk of ovarian cancer by 20 percent. And last May, the American Cancer Society's journal, Cancer, cited a study that showed women who take aspirin daily have a 21 percent lower risk of melanoma than those who don't.

The study, conducted by Stanford University School of Medicine, followed 60,000 white postmenopausal women for 12 years. Neither the exact dosage of aspirin taken during the study nor why the women were taking aspirin was given.

Experts say the two studies remain a work in progress since neither confirms how much aspirin should be taken, the length of time or the effectiveness.

Because aspirin may be harmful for many people, the American Cancer Society isn't recommending that people start popping aspirin in the hopes of preventing cancer. Instead, one's personal physician should monitor the use any of aspirin.

Dr. Matt Purvis, interventional cardiologist and surgeon with University of Colorado Health, agrees.

"We like to keep up on the different recommendations and break down the difference between the use of aspirin as a primary or secondary use. One can be a lifesaver, the other, not," he says. "We look at aspirin from the interventional cardiology aspect when it's integrated into treatment, such as after someone has had a shunt put in."

A primary concern is finding the best use of aspirin in a specific situation.

"Often, the use of aspirin as a preventative comes down to age," says Purvis, who is also director of cardiovascular care at Colorado Health Medical Group and practices at Medical Center of the Rockies and Poudre Valley Hospital.

"People younger than 50 shouldn't be taking daily doses of aspirin because the risk of bleeding can outweigh any preventative measures. On the flip side, over 50, the known benefits outweigh the risks. Aspirin has been proven to reduce non-fatal MIs (myocardial infarctions or heart attacks)."

The real risk of bleeding is under appreciated, Purvis says. "The risks of taking aspirin go up 2-3 times in a patient with gastric ulcers, but for men with heart disease, the use of aspirin allows us to stay on top of the condition. We also take into account a patients' family history. If it's one with strong coronary disease — your mother and your father, for instance — we'll be inclined to prescribe aspirin every day. But if a patient has a bleeding ulcer, we're going to be cautious about risking more bleeding."

No matter the latest buzz about aspirin, Purvis agrees that self-medicating can be dangerous. Patients shouldn't be afraid to ask their physician about new treatments or reports they've read.

"I enjoy those patients who come armed with questions. People want to be pro-active and it's a great opportunity for conversation. It's important to know all the facts before introducing aspirin," he says. "People who are taking many medicines at once should know the dangers of aspirin interacting negatively with those medicines."

But aspirin can be a lifesaver, Purvis says. "As cardiologists, we work in the trenches. By the time we see someone with a blockage, we're wishing that person had been on aspirin therapy."

Conversely, just as doctors hope patients don't self-prescribe, Purvis says taking yourself off aspirin can be just as dangerous due to a rebound effect that can trigger a blood clot, a heart attack or stroke. "If your doctor has prescribed a baby aspirin every day, make sure you follow those directions," he says. "It's a worrisome situation. Stopping without your doctor's advice opens up a whole bunch of risks. It can be a fatal event."

While the proper use of aspirin as a preventative is helpful, Purvis stresses that patients do all they can to make lifestyle changes to keep them heart healthy.

"We fix heart attacks, but that's a reactive situation," he says. "You can't smoke, eat unhealthy foods, be overweight and never exercise, then say to your doctor, 'put a stent in and patch me up, doc.' We'd much rather have you be pro-active in your life and not depend on having us fix a bad situation."

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